Medicaid Matters for Rural America
Strategies for Engaging Rural Constituencies
Rural communities across America stand to benefit significantly from the Medicaid expansion under the
Affordable Care Act (ACA). However, making this clear for policymakers, the media, and the general public in
rural areas is a challenge. In addition, advocates are now faced with the challenge of engaging rural populations
and communities around outreach and enrollment efforts for both Exchanges and the newly-eligible Medicaid
expansion populations. This memo provides tips and tools for consumer health advocates interested in engaging
rural populations and communities in Medicaid expansion campaigns and outreach and enrollment efforts.
Why Medicaid Matters in Rural Communities
Medicaid benefits:
Rural Individuals and Families. The rural population is more likely to be older, lower income, living with
disabilities, and less healthy compared to urban and suburban populations. Furthermore, many rural workers
are self-employed or work as farmers or ranchers and often have less access to employer-sponsored
insurance, leading to high rates of uninsurance and underinsurance.i According to the Center on Budget and
Policy Prioritiesii, more than 2.6 million low-income individuals who live in rural America and who do not
have health insurance could gain health coverage if all states expand Medicaid.
Rural Health Care Infrastructure. Medicaid is crucial for the health care infrastructure in rural
communities. Because of the high uninsurance and underinsurance rate, rural hospitals face much more
uncompensated care. Providers often rely on Medicaid payments to cover the costs of treating many of their
patients. Medicaid also funds services, such as mental health services, which would likely be otherwise
unavailable in rural communities.iii
Rural Economies. Medicaid dollars also contribute to the economy in rural communities. Medicaid funding
benefits rural communities by supporting jobs within the rural health care sectoriv which accounts for around
14 percent of total employment, with hospitals being one of the biggest employers in rural areas.v
Tips for engaging rural constituencies
Build Relationships with Local Newspapers in Rural Communities.
Most rural communities have a weekly newspaper that covers local football games, 4-H fairs,
fundraisers, elections, etc., and residents are often loyal readers.
Building a relationship with the editor of a rural newspaper is key. This takes time, but should not be
intimidating. They are often short-staffed, so compelling stories and good content are often welcome.
Find out their interests, what they like to print and what their deadlines are. Become a reliable source for
information and stories.
Provide opportunities and resources for rural organizations to work on statewide campaigns.
Be mindful of the fact that rural organizations are often under-resourced with little, if any, capacity to
travel across the state to engage in campaign events.
Rural organizations often rely on coalition partners to help produce communications products, such as
templates that can be altered and applied in a way that is useful for their constituents.
The challenge for rural organizations that participate in statewide coalitions is coordinating with
partners who work with an “urban” mindset and expectations. Rural groups need adequate notice to
show up in urban areas for coalition meetings, and often require advanced notice and resources to
transport their constituents.
Community Catalyst is a national non-profit advocacy organization building
consumer and community leadership to transform the American health care system.
www.communitycatalyst.org
Page 2
Medicaid Matters for Rural America, July 2013
Reach rural communities through radio.
Rural workers who are on the go all day working in fields, forests, ranches, etc., do not always have
time to sit down and read a newspaper or an online blog. However, they can listen to the radio
throughout the day. Radio can be one of the most effective ways to reach rural populations.
Place radio ads in rural districts or find opportunities to talk about coverage options on local shows.
Find messengers who are trusted members of the rural communities you are targeting.
Many people in urban areas are from small, rural towns and usually still have family and friends in
those towns. They can help you network in their hometowns.
Partner with extension offices and community action agencies to do outreach and enrollment for the
Medicaid population. These offices and agencies are often local, trusted sources of information.
Local clubs, churches, chambers of commerce, and community health workers are also strategic allies
who can help with outreach in rural communities.
Organize train-the-trainer events, and grant small contracts to activate key partners.
Engage rural constituencies in a culturally sensitive way.
Some rural constituencies do not respond to formal PowerPoint presentations and would prefer to have a
discussion that is unstructured, open, flexible, and honest.
Potential partners to collaborate with in rural areas:
Enroll America
High school students
Young Invincibles
Teach for America
and related
Universities and
organizations
community colleges
Temp agencies
Rural health
associations
Dollar Stores
Children’s coalitions
Thrift Stores
Speech and hearing
DMV
association
Boards of Education
Head Start programs
United Way
Child care centers
Rural media outlets
Rotary clubs
Judges and juvenile
Health fairs
court staff
Mobile health units
Health departments
Student nurses’
Libraries
associations
Faith organizations
Local restaurants
Fraternities and
sororities
VITA volunteers
providing tax
assistance
Community Health
Corps
AARP
County extension
offices
Small business
development centers
Social media
Additional resources:
The Center for Rural Affairs promotes policies that make health insurance affordable for rural
constituencies. Visit their website for more information about the Medicaid expansion’s impact.
Read the Center on Budget and Policy Priorities’ fact sheet that highlights how rural America will
benefit from the Medicaid expansion.
Visit the USDA's website to find your local Cooperative Extension offices.
i
Bailey, John. Medicaid and Rural America. Issue brief no. 15. Center for Rural Affairs, Feb. 2012. Web.
<http://files.cfra.org/pdf/Medicaid.pdf>.
ii
Rural America Will Benefit from Medicaid Expansion. Center on Budget and Policy Priorities, Web. <http://www.cbpp.org/files/Fact-SheetRural-America.pdf>.
iii
ibid
iv
ibid
v
Protect Medicare Dependent Hospitals and Rural Patients. National Rural Health Association, Web. <http://www.ruralhealthweb.org>
Community Catalyst is a national non-profit advocacy organization building
consumer and community leadership to transform the American health care system.
www.communitycatalyst.org